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Before Laennec, respiratory diseases that we recognize today were often confused, because the heart and lung are locked inside the rib cage. Impressed by the autopsies performed by Xavier Bichat (1771-1802), Laennec maintained the importance of the anatomoclinical method. But he indicated in his early 1820s lectures at the Collège de France that the discovery of auscultation was fortuitous and empirical. Duffin demonstrates that medical discoveries hardly obey an implacable logic, they arise outside of pre-established projects. In this paper, we retrace the chronology and antecedents at the origin of the important medical invention that is the stethoscope.

Introduction The recently developed daily and clinical visit PROactive physical activity in COPD (PPAC) instruments are hybrid tools to objectively quantify the level of physical activity and the difficulties experienced in everyday life. Our aim was to translate these instruments for the French-speaking chronic obstructive pulmonary disease (COPD) community worldwide and evaluate the influence of weather and pollution on difficulty score. Methods The translation procedure was conducted following the guidelines for cross-cultural adaptation process. The translated clinical visit (C-PPAC) was tested among COPD patients in France. A retest was conducted after an interval of at least 2 weeks. The C-PPAC difficulty score was then tested to see how sensitive it was to the influence of weather and outdoor pollution. Results One hundred and seventeen COPD patients (age 65±9 years; FEV1: 51±20%) from 9 regions in France were included. The French version of C-PPAC was found comprehensible by the patients with an average score of 4.8/5 on a Likert-scale. It showed good internal consistency with Cronbach's α>0.90 and a good test retest reliability with an intraclass correlation coefficient of ≥0.80. The difficulty score was negatively correlated with duration of daylight (ρ=-0.266; p

International audience; No abstract available

International audience; For reasons of availability and cost, patients are sent home increasingly early, with limited follow-up due to the complexity and size of medical devices. In this context, researchers from IETR and MIPS laboratories are working on a device which should monitor the progress of a patient, in order to detect early the aggravation of a disease such as Chronic Obstructive Pulmonary Disease (COPD) or diabetes with walking disorders. The device is based on flexible piezoelectric thin films (3 µm thick) that can be used as podiatric sensors and have been developed by the IETR laboratory. The originality of this work lies both in the approach to the design of the gait-monitoring device—because it was carried out directly in consultation with a doctor from the University Hospital of Nantes and a podiatrist—and in the portability of the device, which should eventually allow the follow-up of a patient at home. For this study, the flexible piezoelectric sensors have been elaborated using a Chemical Solution Deposition (CSD) process and a commercial aluminum (Al) foil as substrate. In order to increase the flexibility of sensors and to aid its insertion in a shoe, piezoelectric films have been encapsulated by lamination into polyethylene terephthalate (PET, 150 μm). In this paper, the elaboration and characterization of flexible piezoelectric sensors, analog-to-digital converter and wireless communication protocol used for data transmission are presented.

IntroductionCOVID-19 sequelae are numerous and multisystemic, and how to evaluate those symptomatic patients is a timely issue. Klok et al proposed the Post-COVID-19 Functional Status (PCFS) Scale as an easy tool to evaluate limitations related to persistent symptoms. Our aim was to analyse PCFS Scale ability to detect functional limitations and its correlation with quality of life in a cohort of patients, 2–9 months after hospitalisation for COVID-19 hypoxemic pneumonia.MethodsPCFS Scale was evaluated in 121 patients together with quality of life and dyspnoea questionnaires, pulmonary function tests and CT scans.ResultsWe observed a high correlation with multiple questionnaires (Short Form-36, Hospital Anxiety and Depression Scale, modified Medical Research Council, end Borg Six-Minute Walk Test), making the PCFS Scale a quick and global tool to evaluate functional limitations related to various persistent symptoms following COVID-19 pneumonia.DiscussionThe PCFS Scale seems to be a suitable instrument to screen for patients who will require careful follow-up after COVID-19 hypoxemic pneumonia even in the absence of pulmonary sequelae.

Background: the improvement of PA remains a major goal in COPD. Apart from the common benefits of PR, it is unclear which PA parameters assessed by accelerometry best reflect the change in daily physical activity behavior after a home-based PR. Aim: we hypothesized that the change in daily light PA is the most sensitive factor after a home based PR. Methods: 51 COPD patients undergoing home-based PR in 3 different cities in France were analyzed using accelerometers at the beginning and 6 months after home-based PR. Results: the time spent in light PA and the number of steps per day are increased, from 3:53 ± 1:49 to 4:16 ± 1:56 (p=0.003) and from 5362 ± 3176 to 5865 ± 3286 (p=0.039) respectively. We do not observe a change in time spent in moderate PA. Rainfall and daytime temperature influenced pedometry and light PA measures. Conclusion: an increase in time of light intensity PA was observed in patients undergoing a home-based PR, which represents an essential first step against sedentarity. This was not observed about the time in moderate PA which is the common goal in a general population. In chronic diseases such as COPD, we encourage the use of time in light PA that is most sensitive to depict the change in PA behavior.

Background: Cardiopulmonary Exercise Testing (CPET) in patients suffering from chronic obstructive pulmonary disease (COPD) has already proved his value for the assessment of prognosis in such patients, especially through the peak oxygen uptake (peak V’O2). Aim: To assess if V’O2 measured at ventilatory threshold is efficient to predict mortality in COPD patients Methods: Data were available from two cohorts in a university hospital centre in France. COPD patients which have performed a CPET at the beginning of a pulmonary rehabilitation program between 2008 and 2018 were included. Results: Among 104 patients included, 29 died during their follow-up. The V’O2 at the ventilatory threshold, expressed in percentage of the predicted peak V’O2, was identified as a prognostic factor (HR 0.954, 95% ci : 0.921 - 0.989). In a multivariable logistic regression model, including sex, age, heart failure and negative chronotropic treatment, this variable remained associated with mortality (HR 0.944, 95% CI 0.908 - 0.982). The peak V9O2 (percentage reference value) was also associated with mortality as expected (HR 0.953, IC95% 0.924 - 0.982). Conclusion: V’O2 measured at the ventilatory threshold could be one of the best criterion to predict mortality. It has the advantage to be obtain in sub-optimal conditions, less influence by patient motivation. Further analyses are in progress to confirme this preliminary results and to determine the optimal threshold.

BACKGROUND Diagnosis of acute exacerbation (AE) of cystic fibrosis (CF) must be precise because both under- and over-prescription of antibiotics may be detrimental. How lung function tests contribute to diagnose AE is unclear. We aimed to describe variation of spirometry and oscillometry measurements, at Stable state and at AE in adults with CF. METHODS Patients were included in a retrospective single-centre study when both spirometry (FEV1, FVC) and oscillometry (X5, R5, R5-R20 and AX) data were available for at least one Stable and one AE visit between December 2016 and July 2019. For each visit, we calculated variation (Δ) in spirometry and oscillometry indices in comparison with personal best values. Measurements were expressed as % of predicted values and Z-scores when applicable. Areas under ROC curves (AUC) were computed. RESULTS Forty-two patients (28 ± 9 years, FEV1 64 ± 21%) were included; 80 AE and 104 Stable visits were analysed. FEV1 (L, %pred and Z-score) and FVC (%pred and Z-score) varied significantly between AE and Stable visits (p

Background: Diagnosis of acute exacerbation (AE) of cystic fibrosis (CF) must be precise since both under- or over-prescription of antibiotics may be detrimental. How lung function tests contribute to the diagnosis of AE is unclear. Aims: We aimed to describe the diagnostic performance of spirometry and impulse oscillometry (IOS) for the diagnosis of AE. Methods: Adult CF patients were included in a retrospective single-centre study if both spirometry (FEV1, FVC) and IOS (X5, R5) data were available for at least one stable (non-AE) visit and one AE visit between December 2016 and July 2019. AE was defined by a modification of respiratory symptoms and a new antibiotic prescription. For each visit, we calculated the variation (D) in FEV1, FVC, R5 and X5 in comparison with the personal best value. Measurements were expressed as raw values, % of predicted values, and Z-scores. Areas under receiver operating characteristics curves (AUC) were computed. Results: Forty-two patients (age 28+/-9 years, FEV1 64+/-21%) were included; 104 EA visits and 80 non-EA visits were analysed. FEV1 (raw value, %pred and Z-score) and FVC (%pred and Z-score) varied significantly between AE and non-AE visits (p Conclusions: The performance of both spirometry and IOS to diagnose AE was poor. The variation in X5 (raw value) may be helpful in patients where spirometry is unreliable or uncomfortable.

Background: The aetiologies of chronic respiratory failure (CRF) are moving in many western countries. Obesity-Hypoventilation syndrome (OHS) has become one of the most common indications of non-invasive ventilation (NIV) with Chronic Obstructive Pulmonary Diseases (COPD). Long-Term Oxygen Therapy (LTOT) technology is the treatment plan for CRF patients in the new era. Objectives: This study aimed to assess home-based care evolution in CRF patients on LTOT (LTOT) and/or NIV from the ANTADIR observatory. Methods: A computerized database from 14 regional facilities was analysed (30% of French home-treated patients). Patient age, sex, aetiology, home respiratory devices were recorded between 2001 and 2015. Results: By the end of 2015, 12,147 CRF patients received LTOT (40%), NIV (24%), LTOT + NIV (23%), continuous positive airway pressure (CPAP; 11%) or LTOT + CPAP (3%). Between 2001 and 2015, we observed a decrease of LTOT (63–40%) in the benefit of NVI ± LTOT (25–47%). Regarding the aetiology, we note a slight decrease in obstructive disease and a significant increase in restrictive disease, mainly due to OHS. The 10-year survival was better on NIV ± LTOT than on LTOT, for overall patients and for both obstructive and restrictive patients. The 10-year survival was better on NIV ± LTOT than on LTOT (35 vs. 10%, p < 0.05). In COPD patients on LTOT, a switch from conventional to new home devices was observed. Stationary LTOT systems were less prescribed, while portable/transportable ­system, liquid oxygen and self-filling oxygen were increasingly prescribed. Conclusion: Our study confirmed changes in CRF aetiologies and home devices. OHS is now an important indication of NIV. Using new LTOT technologies changed home prescriptions in COPD patients.

Introduction L’oxygenotherapie pulsee (OTP) a ete developpee afin d’augmenter l’autonomie de marche des patients utilisant des concentrateurs d’oxygene portables. Ces dispositifs sont maintenant largement utilises dans la pratique clinique. Cependant, leur impact sur la capacite a la marche est mal evalue. L’objectif de cette etude etait d’evaluer la capacite a l’exercice evaluee au cours d’un test de marche de 6 minutes lorsque le concentrateur etait utilise en OTP comparativement a son utilisation en debit continu. Methodes Nous avons conduit une etude controlee prospective randomisee en cross-over et multicentrique. L’etude etait promue par la Federation ANTADIR. Huit concentrateurs d’oxygene portables differents ont ete evalues. Pour chaque concentrateur, un minimum de 25 patients ont realise deux tests de marche de 6 minutes dans un ordre aleatoire avec l’appareil regle en mode continu ou en mode pulse. Nous avons enregistre la distance parcourue, la saturation a la fin de chaque test et la dyspnee (echelle de Borg). Un test ANOVA avec correction pour comparaison multiple a ete utilise. Resultats Les participants a l’etude avaient un âge median de 65 ans [60–71] et un indice de masse corporelle de 24 kg/m2 [20-–28]. 234 evaluations ont ete realisees. La distance mediane parcourue en mode continu etait de 320 m [226–415] et de 320 m [226–426] en utilisant OTP (ns). Il n’y avait pas de difference significative entre les 8 differents concentrateurs d’oxygene portables. La dyspnee de fin de test etait similaire entre les groupes: 4 sur 10 [3–6] (ns) ainsi que la saturation de fin de test: 89% [85–91] dans le groupe continu et 89% [86–92] dans le groupe OTP (ns). On ne retrouvait pas de difference significative en ce qui concerne la dyspnee et la saturation de fin de test entre les differents concentrateurs evalues. Conclusion Dans notre etude, l’utilisation d’une OTP n’etait pas associee a une diminution de la distance de marche parcourue et permettait d’obtenir une saturation et une dyspnee de fin d’effort similaire a l’administration continue d’oxygene. Les performances de tous les appareils testes etaient comparables.

Trija Vaidya,1,2 Claire de Bisschop,2 Marc Beaumont,3,4 Hakima Ouksel,5 Véronique Jean,6 François Dessables,7 Arnaud Chambellan,1,8 On behalf of IRSR RéhaEffort cohort group 1Explorations Fonctionnelles Respiratoires, l’institut du thorax, CHU de Nantes, 2Université de Poitiers, Laboratoire MOVE EA 6314, F-86000 Poitiers, 3Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, 4European University of Occidental Brittany, EA3878, Brest, 5Service de Pneumologie, CHU d’Angers, Angers, 6Service de Réhabilitation Respiratoire, Soins de Suite et Rééducation, CHU de Nantes, 7Service de Réhabilitation Respiratoire, la Tourmaline, UGECAM, 8Université de Nantes, Laboratory EA 4334 “Mouvement, Interactions, Performance,” Nantes, France Background: The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR).Methods: COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods.Results: Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P

Resume Introduction L’anemie est frequente dans la BPCO et de mauvais pronostic. Le poids des comorbidites sur la presence d’une anemie est probablement important mais peu connu ainsi que son retentissement medico-economique en France. Methodes Sur une periode de 6 mois de consultations de pneumologie, 151 patients atteints de BPCO ayant eu une exploration fonctionnelle respiratoire, une gazometrie arterielle et/ou une numeration sanguine ont ete retrospectivement selectionnes. Le score de comorbidite de Charlson, les donnees medico-economiques de l’annee precedant l’inclusion et la mortalite a trois ans des patients anemiques ont ete compares a des patients non anemiques apparies sur le sexe, l’âge ± 10 ans et le stade GOLD. Resultats La prevalence de l’anemie etait de 18,5 %, sans influence du stade GOLD. Son depistage etait similaire a partir du gaz du sang ou de la numeration sanguine. La presence de comorbidites – principalement cardiovasculaires – etait retrouvee chez 86 % des anemiques. Compares au groupe BPCO non anemiques, les anemiques avaient un score de Charlson a 5,4 ± 2 versus 4,1 ± 1,5 ( p p Conclusions L’anemie des patients atteints de BPCO est de depistage simple, le plus souvent associee aux comorbidites notamment cardiovasculaires et constitue un facteur predictif important de la mortalite a trois ans. Une tendance non significative au surcout, notamment par hospitalisations, etait observee mais demande a etre confirmee par une etude medico-economique plus importante.

Background: The recently developed PROactive physical activity in COPD (PPAC) instruments are suitable tools for subjective and objective measure of physical activity (PA). Our aim was to translate and evaluate the PPAC instruments in a french population. Methods: The translation procedure for the daily and clinical visit PPAC (D- and C-PPAC respectively) was conducted following the guidelines for the cross-cultural adaptation process. After reaching a consensus on any discrepancies at each stage by an expert committee, a pre-final version was produced. This version was tested among COPD patients from different centers. The adapted version was tested for reliability in a french COPD population. Results: 103 COPD patients from 18 different departments in France were included in this study. The french C-PPAC showed a good internal consistency with a Cronbach’s α > 0.90. The questions were found to be comprehensible with an average score of 4.7/5 on a Likert-scale. The difficulty score obtained in our study was similar to the one obtained by the PROactive consortium: 27 (21-31.5) vs 28 (22-34) [median (P25-P75)] respectively. The amount score 4 (3-5) was obtained without accelerometer data. The questionnaire also produced a good reliability (ICC ≥ 0.85). Conclusion: The french versions of C and D-PPAC are well accepted by the patients. We encourage the use of these tools, notably during pulmonary rehabilitation. The value and sensitivity of the PPAC scores from the french version still need to be investigated in the follow up of COPD patients.

Background: The measure of quadriceps muscular strength is recommended in COPD patients, notably during a pulmonary rehabilitation program (PRP). However, the tools used to measure quadriceps maximal voluntary contraction (QMVC), and the clinical relevance of the results for a given patient remain poorly investigated. We aimed to evaluate the minimal important difference (MID) of QMVC using a fixed dynamometer in COPD patients. Methods: QMVC was measured in COPD patients undergoing a PRP between 2014 and 2016 using a handheld dynamometer microFET2TM fixed on a rigid table. Measures were performed at baseline and end of PRP as well as the 6-minute walk distance (6MWD), the St George’s Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression (HAD) score. The MID was calculated using distribution and anchor-based methods. Results: 157 COPD patients (Age 63 ± 9 years; FEV1: 47.3 ± 18.6% pred) were included in this study. The change of QMVC from baseline to the end of PRP was 8.9 ± 15.6 Nm (p Conclusion: Simple QMVC evaluation using a fixed dynamometer is a reliable and responsive measure for depicting the improvement of quadriceps muscle strength at the end of PRP. We suggest a MID of 8 Nm to identify the beneficial change perceived at the end of PRP.

Physical activity evolution measured by actimeter in COPD patients after a pulmonary rehabilitation. 28. International Congress of the European-Respiratory-Society (ERS)

International audience; Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The “Lung Function” thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.; Le test de provocation bronchique à la méthacholine est couramment utilisé pour la prise en charge de l’asthme. Le groupe de travail « Fonction Respiratoire » de la SPLF propose ici une série de recommandations concernant la réalisation et l’interprétation de ce test, élaborées dans l’esprit de la méthodologie proposée par la Haute Autorité de santé. Les thèmes abordés sont le choix des critères de jugement, la gestion des inspirations profondes, ainsi que la place du test dans la prise en charge de l’asthme, de l’asthme induit par l’exercice et de l’asthme professionnel.

Trija Vaidya,1,2 Marc Beaumont,3,4 Claire de Bisschop,1 Lucie Bazerque,5 Camille Le Blanc,6 Anne Vincent,7 Hakima Ouksel,8 Arnaud Chambellan2,9 1Laboratory MOVE (EA6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France; 2Laboratory “Movement, Interactions, Performance” (EA4334), Faculty of Sport Sciences, University of Nantes, Nantes, France; 3Pulmonary Rehabilitation unit, Morlaix Hospital Centre, Morlaix, France; 4EA3878 (G.E.T.B.O), CHU Brest, Brest, France; 5Institute of Physical Education and Sports Sciences (IFEPSA), Université Catholique de l’Ouest (UCO), Angers, France; 6Physical Medicine and Rehabilitation Department, University Hospital of Nantes, Nantes, France; 7Respiratory Rehabilitation Service, la Tourmaline, UGECAM, Nantes, France; 8Dept of Pulmonary Medicine, Angers University Hospital, Angers, France; 9l’institut du Thorax, University Hospital of Nantes, Nantes, France Background: Measurement of quadriceps muscular force is recommended in individuals with COPD, notably during a pulmonary rehabilitation program (PRP). However, the tools used to measure quadriceps maximal voluntary contraction (QMVC) and the clinical relevance of the results, as well as their interpretation for a given patient, remain a matter of debate. The objective of this study was to estimate the minimally important difference (MID) of QMVC using a fixed dynamometer in individuals with COPD undergoing a PRP. Methods: Individuals with COPD undergoing a PRP were included in this study. QMVC was measured using a dynamometer (MicroFET2) fixed on a rigid support according to a standardized methodology. Exercise capacity was measured by 6-minute walk distance (6MWD) and evaluation of quality of life with St George’s respiratory questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) total scores. All measures were obtained at baseline and the end of the PRP. The MID was calculated using distribution-based methods. Results: A total of 157 individuals with COPD (age 62.9±9.0 years, forced expiratory volume in 1 second 47.3%±18.6% predicted) were included in this study. At the end of the PRP, the patients had improved their quadriceps force significantly by 8.9±15.6 Nm (P

GLI equations provide new cut-offs for TLCOfor detection of PH in patients with SSc, either with or without ILDhttp://ow.ly/aCpD30l2zch

Introduction Le depistage de l’hypertension pulmonaire (HTP) chez les patients atteints de sclerodermie systemique (ScS) est primordial car l’initiation de traitement adapte permet d’ameliorer la survie. Un des principaux outils utilises pour le depistage sont la mesure du transfert pulmonaire du monoxyde de carbone (TLCO) et de la capacite vitale forcee (CVF). Comme ces mesures sont exprimees en pourcentage de la valeur predite ( % pred), les equations de reference pour calculer les valeurs predites sont d’une importance capitale pour l’interpretation. De nouvelles equations de reference pour la CVF et pour le TLCO, basees sur un large echantillon de sujets normaux, ont recemment ete publiees par le groupe Global Lung Function Initiative (GLI). Objectif comparer les seuils optimaux de TLCO et du ratio CVF/TLCO pour l’identification de l’HTP chez les patients ScS, en utilisant soit les equations de reference utilisees jusqu’a present soit les nouvelles equations GLI. Methodes Au total, 572 patients ScS consecutifs non selectionnes ont ete recrutes retrospectivement dans sept centres francais. Tous les patients ont beneficie d’EFR, d’une echographie cardiaque transthoracique ainsi que d’un catheterisme cardiaque droit lorsqu’une HTP etait suspectee. Resultats Parmi les 572 patients atteints de ScS inclus, 58 presentaient une HTP (35 avaient a la fois une HTP et une pneumopathie interstielle diffuse (PID)) et 514 n’avaient pas d’HTP (313 n’ayant aucune atteinte pulmonaire, 201 avait une PID sans HTP). Chez les patients ScS sans PID, l’analyse des courbes ROC a montre que le seuil optimal de TLCO etait plus eleve (70 % vs 60 % pred) avec l’equation GLI comparee aux anciennes equations pour la detection de l’HTP. Les seuils optimaux etaient cependant similaires pour les patients atteints de SSc avec ILD. Pour le rapport CVF/TLCO nous avons identifie un seuil optimal similaire pour les patients atteints de ScS sans PID, quelles que soient les equations utilisees. Ce seuil etait cependant inferieur d’environ 15 % chez les patients atteints de SSc avec PID avec les equations GLI comparees aux anciennes equations. Conclusion En conclusion, nous fournissons ici les valeurs seuils obtenues avec les nouvelles equations GLI pour le depistage de l’hypertension pulmonaire. Nous suggerons de prendre en compte uniquement la TLCO (et non le ratio CVF/TLCO), avec un seuil de 70 % (ou un score z de −2,00) pour le depistage de l’HTP chez les ScS sans PID et de 50 % (ou un z-score de −3,50) chez les patients atteints de ScS avec PID.

International audience; Long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk for treatment-related adverse events, that may worsen physical capacity and may induce fatigue and disability. The aims of this prospective study were to evaluate exercise capacity in allotransplant survivors and its relationship with fatigue and disability. Patient-reported outcomes and exercise capacity were evaluated in 71 non-relapse patients 1 year after allo-HSCT, using validated questionnaires, cardiopulmonary exercise testing (CPET) with measure of peak oxygen uptake (peakVO2) and deconditioning, pulmonary function testing, echocardiography and 6-min walk test. A high proportion (75.4%) of allo-HSCT survivors showed abnormal cardiopulmonary exercise testing parameters as compared to predicted normal values, including 49.3% patients who exhibited moderate to severe impairment in exercise capacity and 37.7% patients with physical deconditioning. PeakVO2 values were not accurately predicted by 6-min walk distances (r = 0.53). Disability and fatigue were strongly associated with decreased peakVO2 values (p = 0.002 and p = 0.008, respectively). Exercise capacity was reduced in most allo-HSCT long-term survivors. Because reduced exercise capacity was associated with fatigue, disability and a decrease in quality of life, cardiopulmonary exercise testing should be performed in every patient who reports fatigue and disability.

Lung function tests have a major role in respiratory medicine. Training in lung function tests is variable within the European Union. In this study, we have shown that an internship in a lung function tests laboratory significantly improved the technical and diagnostic skills of French respiratory trainees.

Malnutrition is frequent and of multiple causes in chronic respiratory diseases. Nutritional assessment is easy and important as it provides important determinants of prognosis of the disease. The nutritional intervention is thus a cornerstone of the multimodal and optimal management of these patients in the context of a pulmonary rehabilitation program.; La dénutrition est fréquente et de causes multiples dans l’insuffisance respiratoire chronique. Son dépistage est simple et d’autant plus important que la baisse de la masse maigre est de mauvais pronostic. La prise en charge nutritionnelle est à mettre en place au mieux dans le cadre d’un programme de réhabilitation respiratoire où la renutrition est associée à la reprise de l’activité physique.

Summary To promote early screening of patients with suspected Primary Ciliary Dyskinesia (PCD), nasal nitric oxide (nNO) measurements during tidal breathing (TB) have been developed for children unable to ensure velum closure (VC) during breath hold or expiration against resistance. To investigate technical and practical issues related to TB-nNO methods in children referred for suspected or asserted PCD, we recorded, in a prospective multicenter study, TB-nNO (calculated as the mean of 5 peaks, 10 or 30 sec during tidal breathing) and VC-nNO when available. We studied 142 children (PCD diagnosis asserted in 47, excluded in 39). Nasal NO values were significantly different according to methods, VC-nNO being higher than TB-nNO (TB-nNO 5 peaks higher than mean of 10 or 30 sec). Specificity (90–94%) and sensitivity (86–97%) were similar between TB-nNO and VC-nNO methods. Age was more correlated with VC-nNO than with TB-nNO. TB-nNO could differ between the two nostrils by more than 10% (or 10 ppb when nNO absolute value lower 100 ppb) in 32–43% of the tested children, according to the different tidal breathing values, and was reproducible in the long term but influenced by ambient NO. Despite TB-nNO values being lower than VC-nNO, TB-nNO was found to be as discriminant for PCD, and probably more discriminant in children less than 8 years old, as the VC method. These results were obtained using the chemiluminescence technique which allows an easier assessment of relevant factors such as nasal permeability and ambient NO than the electrochemical technique. Pediatr Pulmonol. 2015; 50:1374–1382. © 2015 Wiley Periodicals, Inc.

The change in the sit-to-stand test after a pulmonary rehabilitation is not influenced by the initial value http://ow.ly/i2CI30eqprD

International audience; Background: Sit-to-stand tests (STST) have recently been developed as easy-to-use field tests to evaluate exercise tolerance in COPD patients. As several modalities of the test exist, this review presents a synthesis of the advantages and limitations of these tools with the objective of helping health professionals to identify the STST modality most appropriate for their patients.Method: Seventeen original articles dealing with STST in COPD patients have been identified and analysed including eleven on 1min-STST and four other versions of the test (ranging from 5 to 10 repetitions and from 30 s to 3 min). In these studies the results obtained in sit-to-stand tests and the recorded physiological variables have been correlated with the results reported in other functional tests.Results: A good set of correlations was achieved between STST performances and the results reported in other functional tests, as well as quality of life scores and prognostic index. According to the different STST versions the processes involved in performance are different and consistent with more or less pronounced associations with various physical qualities. These tests are easy to use in a home environment, with excellent metrological properties and responsiveness to pulmonary rehabilitation, even though repetition of the same movement remains a fragmented and restrictive approach to overall physical evaluation.Conclusions: The STST appears to be a relevant and valid tool to assess functional status in COPD patients. While all versions of STST have been tested in COPD patients, they should not be considered as equivalent or interchangeable.

Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. Methods Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naive asthma and/or respiratory allergy. Results The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. Conclusion The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.

Screening is important to determine whether patients with systemic sclerosis (SSc) have pulmonary hypertension because earlier pulmonary hypertension treatment can improve survival in these patients. Although decreased transfer factor of the lung for carbon monoxide (TLCO) is currently considered the best pulmonary function test for screening for pulmonary hypertension in SSc, small series have suggested that partitioning TLCO into membrane conductance (diffusing capacity) for carbon monoxide (DMCO) and alveolar capillary blood volume (VC) through combined measurement of TLCO and transfer factor of the lung for nitric oxide (TLNO) is more effective to identify pulmonary hypertension in SSc patients compared with TLCO alone. Here, the objective was to determine whether combined TLCO–TLNO partitioned with recently refined equations could more accurately detect pulmonary hypertension than TLCO alone in SSc.For that purpose, 572 unselected consecutive SSc patients were retrospectively recruited in seven French centres.Pulmonary hypertension was diagnosed with right heart catheterisation in 58 patients. TLCO, TLNO and VC were all lower in SSc patients with pulmonary hypertension than in SSc patients without pulmonary hypertension. The area under the receiver operating characteristic curve for the presence of pulmonary hypertension was equivalent for TLCO (0.82, 95% CI 0.79–0.85) and TLNO (0.80, 95% CI 0.76–0.83), but lower for VC (0.75, 95% CI 0.71–0.78) and DMCO (0.66, 95% CI 0.62–0.70).Compared with TLCO alone, combined TLCO–TLNO does not add capability to detect pulmonary hypertension in unselected SSc patients.

a Inserm U1042, laboratoire HP2, pole locomotion, reeducation et physiologie, clinique physiologie, sommeil et exercice, CHU de Grenoble, universite de Grenoble, 38000 Grenoble, France b Centre de pneumo-allergologie, les acacias, 05107 Briancon, France c Inserm U1046, departement de physiologie, service physiologie clinique, hopital Arnaud de Villeneuve, CHU de Montpellier, 34295 Montpellier, France d Service d’explorations fonctionnelles respiratoires et clinique des maladies respiratoires, hopital Calmette, CHRU de Lille, 59037 Lille, France e Inserm U1087, institut du thorax, CHU de Nantes, 44093 Nantes, France

Introduction L’objectif de ce travail a ete d’analyser l’evolution du traitement a domicile de l’insuffisance respiratoire chronique (IRC) en France pendant 15 ans, a partir des donnees de l’observatoire de la Federation ANTADIR. Methodes Nous disposions des donnees annuelles informatisees de 14 structures regionales de prise en charge de l’IRC a domicile. Ces donnees concernaient l’oxygenotherapie de longue duree (OLD), la ventilation non invasive (VNI) et la pression positive continue (PPC). Les variables suivantes ont ete analysees : âge, sexe, etiologies, types de dispositif, date d’arret de traitement ou date de deces. Resultats Fin 2015, 12 147 patients etaient traites soit par OLD (40 %), soit par VNI (24 %), VNI + OLD (23 %), PPC (11 %), OLD + PPC (3 %). Entre 2001 et 2015, le nombre de femmes a statistiquement augmente pour la prise en charge de l’IRC. Une baisse de la prescription d’OLD (63 a 40 %) est notee au cours du temps, alors que la prescription de VNI augmente (35 a 45 %) et VNI + OLD (25 a 46 %). Sur le plan des etiologies, les maladies obstructives diminuent, alors que les maladies restrictives augmentent du fait d’une progression du syndrome d’obesite hypoventilation (SOH). La survie est statistiquement meilleure chez les patients avec VNI, comparativement a l’OLD. Ces patients sont plus jeunes et les etiologies diverses avec SOH et BPCO. Pour les dispositifs d’OLD, la prescription des concentrateurs fixes diminuent au profit des concentrateurs portables et transportables. La prescription d’oxygene liquide est stable et les systemes de remplissage sont peu utilises. Ces donnees representent 30 % des prescriptions en France. Nous ne disposons pas des comorbidites des patients et de l’observance pour l’OLD. Conclusion Les donnees de l’observatoire confirment que les femmes sont de plus en plus concernees par le traitement de l’IRC. Les etiologies evoluent avec de plus en plus de SOH. Les nouvelles technologies permettent une meilleure mobilite des patients sous OLD. La federation ANTADIR a lance une cohorte en 2015 concernant la VNI a domicile et nous envisageons de debuter une cohorte sur l’OLD. Remerciements a tous les SARD de la federation ANTADIR pour la transmission de leurs donnees.

The VQ11 belongs to the health-related quality of life9s instruments conceptually more focused on the Functional, psychological and social impact of COPD. There is to date no data on the change of this questionnaire and the Minimal Important Difference (MID) after a PRP. 117 COPD patients (65.4 years, FEV1 52.4% predicted) were included in this study. They all fulfilled a complete evaluation at baseline, followed by a PRP as recommended. The assessment was made 6 months after the first visit. The change in the different components of the VQ11 were compared with the change of other quesitonnaires and the 6MWD. The most relevant and significant variables were chosen as anchor to provide the MID for the VQ11. The VQ11 total score changes from 28.6 ± 9.4 to 27.3 ± 9.3 (p=0.01). For the Functional, Psychological and Social components, it changes from 9.2 ± 3.1, 10.2 ± 3.2, and 9.4 ± 4, to 8.9 ± 3.3 (p=0.06), 9.9 ± 3.4 (p=0.02), and 8.5 ± 3.6 (p=0.002) respectively. Using the distribution-based method, the MID for the total VQ11 score was -3.4. The total SGRQ, HAD-Depression and 6MWD changes were selected as anchors. Using the ROC curve analysis, the MID for the total VQ11 ranged between -3.5 and -4.5. For the Functional, Psychological and Social components the threshold of -1.5, -1.5 and -2.5 are suggested. The VQ11 is sensitive to measure behavioral change in COPD patients undergoing PRP. An estimate of 4 is suggested. It would be valuable to compare these results in other cohorts to confirm the strength of this threshold.

While life expectancy after allogeneic hematopoietic stem cell transplantation (AHSCT) gradually improves, physical morbidity increases in survivors. Many factors contribute to exercise intolerance and altered physical performance. Cardiopulmonary exercise testing (CPET) is an easy measure of physical function but is rarely performed during follow-up after AHSCT. We conducted a prospective study on 71 patients (25 females; 60±11 years) who underwent AHSCT mainly for acute myeloblastic leukemia (n=28) and lymphoma (n=15). Clinical evaluation, lung function tests and health-related quality of life (HRQoL) evaluation with the 36-item Short Form Health Survey (SF-36) were performed one year after AHSCT. Peak oxygen uptake (VO2) was also assessed in 69 patients who were able to perform CPET. 26 patients (37%) reported disabilities, especially related to fatigue. Importantly, lung function was not significantly altered (FEV 1 104±19% pred.; FVC 108±18% pred.), while 34 patients (48%) displayed peak VO2 150 min/week after hospital discharge had a higher peak VO2 (p=0.028 and 0.008, respectively). Together with a clinical evaluation focusing on fatigue, peak VO2 measurement is of marked interest to identify patients who will require rehabilitation after AHSCT. Pulmonologists should better collaborate with hematologists to assess these patients using CPET one year after AHSCT.

The STST1 could be valuable to assess the level of exercise tolerance in COPD. There is a need to clarify 1) if a familiarization test is required, 2) the reliability of the test, and 3) the responsiveness to a PRP in terms of a minimal important difference (MID). 32 COPD patients and 14 healthy individuals were included. The STST1 was performed twice at 15 minutes interval and repeated after 48 hours. A complete evaluation was obtained at the inclusion and the end of the PRP as recommended. Responsiveness to PR was determined by the difference in the STST1 from the inclusion to the end of PRP. In the COPD group (64.1 ± 10.4 years; FEV 1 of 53.2 ± 16% predicted) and the healthy group (59.4 ± 6.1 years), there was a tendency for a familiarization effect from 16.5 ± 4.0 to 17.4 ± 4.4 ( p =0.138) in COPD, and from 37.0 ± 8.4 to 39.1.3 ± 9.2 ( p =0.097) in the healthy group respectively. The STST1 showed excellent test-retest reliability in both groups with the ICC of 0.903 (95CI: 0.697 to 0.969) in COPD and 0.977 (95CI: 0.925 to 0.993) in the healthy group. The STST1 was correlated with the 6MWD (r = 0.649, p -4 ). In the COPD group, the number of STS rose from 18.1 ± 5.5 to 22.4 ± 7.6 (p=0.001). Using the distribution-based method, the MID was 3. With the 6MWD and the quadriceps strength as anchored, it was between 2 and 7 (AUC 0.704) and 2.5 and 3.5 (AUC 0.857) respectively. The STST1 is a simple and reliable field test sensitive to measure the effect of a pulmonary rehabilitation program. Based on these result, we suggest to set the MID at 3.

International audience; Introduction: Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise performance. Even if this parameter is routinely evaluated using 6-minute walking test (6MWT), new field tests are regularly investigated as alternative tests. The aim of this study was to compare functional exercise performance evaluation by sit-to-stand test (STST) and 6MWT and to evaluate reliability and repeatability of the STST in COPD patients.Method: Forty-two COPD patients performed randomly two tests: 6MWT and STST. Each test was repeated two times. Distance (6MWD) and number of repetitions were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded before and after the tests.Results: Sit-to-stand repetitions (19 ± 6) and 6MWD (441 ± 104 m) were correlated (r = .716; P < .001). Good repeatability was found for STST and 6MWT. Good reliability was observed for STST (ICC = 0.902). Variations of heart rate and pulsed oxygen saturation were significantly different between these two tests (23% ± 17% vs 13% ± 11%; P = .022 and -7.6% ± 4.6% vs -0.7% ± 2.7%; P < .001 for 6MWT and STST, respectively). Variations of dyspnea and lower limb fatigue were similar between both tests (P = .827 and P = .467).Conclusion: The one minute sit-to-stand test is a valuable alternative to 6MWT to estimate functional exercise performance in COPD patients. The cardiorespiratory demand is different between both tests although the variation of dypsnea is similar. No learning effect was observed for STST

National audience; L’insuffisance respiratoire chronique obstructive secondaire à la broncho-pneumopathie chronique obstructive (BPCO) combine les effets délétères de l’hypoxie chronique, l’inflammation chronique, l’insulinorésistance, l’augmentation de la dépense énergétique, la fonte musculaire, et le déconditionnement à l’exercice. Comme pour d’autres maladies chroniques, la perte de masse non grasse diminue la survie. Préserver la masse et la fonction musculaires en maintenant le métabolisme mitochondrial oxydatif est un point clé de la prise en charge du patient BPCO. Du fait du vieillissement de la population, de l’augmentation de prévalence de la BPCO et du progrès médical, les années futures vont connaître l’augmentation de la prévalence de la dénutrition chez les patients BPCO. L’androgénopénie, ou l’hypogonadisme, définie par une testostéronémie libre inférieure à 50 pg/mL, est observée chez 40 % des patients BPCO. Comme les androgènes stimulent l’anabolisme musculaire, l’androgénopénie s’associe à une fonte musculaire. Des études, dont une récente méta-analyse, indiquent que l’androgénothérapie pouvait augmenter l’indice de masse corporelle et la masse non grasse, ainsi que la qualité de vie des patients BPCO, mais, seule, était insuffisante pour améliorer la fonction respiratoire. Deux essais randomisés multicentriques ont démontré que l’association androgénothérapie–exercice physique–compléments nutritionnels oraux contenant des acides gras poly-insaturés oméga-3, pendant au moins trois mois, diminuait la morbi-mortalité. Ce traitement multimodal est optimisé dans le cadre de la réhabilitation respiratoire, qui est le traitement de référence de la dénutrition du patient BPCO. / Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to augmentation in future decades. Androgenopenia, or hypogonadism, defined by free testosterone plasma concentrations below 50 pg/mL, is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies, including one recent meta-analysis, indicate that androgen substitution could improve body mass index and fat-free mass as well as quality of life in COPD patients, but, alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids in the context of pulmonary rehabilitation, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation, which is the reference therapy of COPD-associated undernutrition

Erythropoiesis is modified in chronic obstructive pulmonary disease (COPD). Tobacco smoke, hypoxaemia, systemic inflammation, and infectious exacerbations are the main factors involved. Polymorphisms in genes involved in the regulation of erythropoiesis probably explain the individual susceptibility and variability in the response. The roles of comorbidities related to COPD and the impact of treatment on erythropoiesis are important confounding factors. While polycythaemia is often related to tobacco smoke and hypoxaemia, it has become less common due to the improvement of COPD follow-up and especially the initiation of long-term oxygen therapy. The control of the main causes is often sufficient, but in cases of severe polycythaemia an erythrapheresis is indicated. Anaemia has recently been reported as a more common and serious complication. It increases dyspnoea and reduces physical activity and quality of life. Its impact on survival and the requirements for healthcare has recently been confirmed. The main approach to the management of anaemia remains exclusion of any curable causes, reducing exacerbations and systemic inflammation, and controlling the comorbidities. Though erythropoietin has some benefits in the so-called "anaemia of chronic disease", this still remains to be confirmed in patients with COPD.

Resume Objectif Observer, au travers d’une enquete nationale, si la realisation du test de marche de six minutes (TDM6) est en accord avec les recommandations de l’American thoracic society (ATS). Methode Un questionnaire anonyme est adresse par voie electronique a 206 services de pneumologie (39 CHU et 167 CHG) et aux structures de rehabilitation respiratoire grâce au groupe Alveole de la SPLF, puis diffuse sur un site de discussion specialise en kinesitherapie respiratoire et un site d’informations professionnelles en kinesitherapie et physiotherapie. Resultats Cent onze questionnaires sont retournes entre octobre 2009 et avril 2010, 105 provenant de France (95 %). Le taux global de reponses des hopitaux est de 30 %. Le TDM6 est realise principalement par des kinesitherapeutes et des infirmieres. Dans 48 % des cas il n’y a pas de moment defini pour sa realisation. Le parcours utilise est un couloir superieur a 30 metres (52 % des cas). Dans 60 % des cas, le patient est accompagne par l’operateur. Un test de familiarisation est realise dans 35 % des cas, avec un delai d’attente entre les deux tests inferieur ou egale a 30 minutes (62 % des cas). Dans 40 % des cas des encouragements sont donnes. La SpO 2 est surveillee durant le TDM6 dans 95 % des cas. Conclusion Pour plusieurs items, les recommandations de l’ATS ne sont pas suivies. Les differences retrouvees ont pour principales causes les contraintes liees aux services (disponibilite des operateurs et/ou des patients).

Resume Introduction La dyskinesie ciliaire primitive (DCP) est une maladie qui associe des symptomes pulmonaires et oto-rhino-laryngologiques. Un diagnostic precoce permet de prevenir les bronchectasies. Cette etude retrospective avait pour but de revoir les donnees cliniques et paracliniques d’enfants suspects de DCP. Resultats Au total, 89 enfants ont eu une etude de l’ultrastructure des cils entre 2000 et 2009. Le diagnostic a ete porte chez 17 enfants. Une bronchopneumopathie est retrouvee dans 82 % des cas, 82 % ont des otites chroniques, 37 % une sinusite et 23 % un situs inversus. Ces patients avaient des anomalies des bras de dyneine dans 59 % des cas, du complexe central dans 35 % et des deux dans 6 %. La production nasale d’oxyde d’azote (NO) est en accord avec le resultat de la microscopie electronique dans 16 cas : cinq DCP, 11 sans DCP. Dans deux cas, les resultats sont discordants. Conclusion Les symptomes discriminants pour le diagnostic de DCP sont les otites chroniques, les sinusites et le situs inversus, plus particulierement lorsqu’ils surviennent dans un contexte de bronchopneumopathie. Des mesures du NO nasal elevees rendent improbables le diagnostic de DCP. Mais les resultats peuvent etre intermediaires et la microscopie electronique reste indispensable pour poser le diagnostic et guider la genetique.

Inflammation plays a central role in the pathophysiology of chronic obstructive pulmonary disease (COPD). Exposure to cigarette smoke induces the recruitment of inflammatory cells in the airways and stimulates innate and adaptive immune mechanisms. Airway inflammation is involved in increased bronchial wall thickness, increased bronchial smooth muscle tone, mucus hypersecretion and loss of parenchymal elastic structures. Oxidative stress impairs tissue integrity, accelerates lung ageing and reduces the efficacy of corticosteroids by decreasing levels of histone deacetylase-2. Protease–antiprotease imbalance impairs tissues and is involved in inflammatory processes. Inflammation is also present in the pulmonary artery wall and at the systemic level in COPD patients, and may be involved in COPD-associated comorbidities.Proximal airways inflammation contributes to symptoms of chronic bronchitis while distal and parenchymal inflammation relates to airflow obstruction, emphysema and hyperinflation. Basal levels of airways and systemic inflammation are increased in frequent exacerbators.Inhaled corticosteroids are much less effective in COPD than in asthma, which relates to the intrinsically poor reversibility of COPD-related airflow obstruction and to molecular mechanisms of resistance relating to oxidative stress. Ongoing research aims at developing new drugs targeting more intimately COPD-specific mechanisms of inflammation, hypersecretion and tissue destruction and repair. Among new anti-inflammatory agents, phosphodiesterase-4 inhibitors have been the first to emerge.